Expert Witness Journal Issue 67 June/July 2026 - Flipbook - Page 45
•
2019–2022: No chest X-ray was undertaken.
There is no evidence that Mr Ahmed was aware
of an outstanding investigation.
•
•
January 2022: Mr Ahmed stated in a witness
statement that he had not been told to attend
for an X-ray.
There was no evidence of informed non-attendance.
February 2023: Mr Ahmed died from lung
cancer.
The defence failed.
•
3. Contributory Negligence
The court found no evidence that Mr Ahmed
knew about the X-ray or understood any risk in
not attending follow-up. Non-attendance could not
therefore be characterised as negligent, and the
burden of proof was not met.
The Claimants alleged failure to communicate the
X-ray request and its process. The Defendant relied
on usual practice but had no speci昀椀c recollection.
The court was asked to determine breach, causation,
and contributory negligence.
GP Expert Witness Perspective
The court was asked to determine three preliminary
issues:
1.
Whether the Defendant failed to inform Mr
Ahmed of the X-ray request;
2.
If so, whether Mr Ahmed would have attended
had he been informed;
3.
Whether Mr Ahmed was contributorily
negligent in failing to attend subsequent followup appointments.
expected engagement with serious pathology
exclusion.
The facts will be immediately recognisable to any
practising GP. Speaking as a GP who also works in
medico-legal cases, what stands out in this case is
how ordinary it all is. There’s nothing exotic here
clinically. No diagnostic outlier. No missed red
昀氀ags in the traditional sense. The dispute turns on
something far more familiar in general practice:
communication, timing, and what the record does—
or doesn’t—show.
The key issue isn’t diagnosis, it’s communication
The Judge’s Conclusion and Reasoning
What the court was really trying to establish wasn’t
whether the GP acted competently in clinical terms.
It was much narrower and, in some ways, more
unforgiving: was the patient told about the chest
X-ray, and did he know how to act on it?
Christopher Kennedy KC, sitting as a Deputy
High Court Judge, found for the Claimants on all
preliminary issues. The court held, on the balance
of probabilities, that Dr Daish did not inform Mr
Ahmed of the need to attend for a chest X-ray,
despite being described as a “caring and competent”
clinician.
1. Communication of the X-ray
That’s a question every GP recognises. It’s the “I’m
sure I told them” problem, which in day-to-day
practice is usually true—but legally, it has to be
demonstrable.
The court relied primarily on the contemporaneous
record:
The record tells the story, not memory
•
No documentation of discussion: The record
con昀椀rmed the X-ray request but contained no
evidence that it was explained to the patient,
unlike other investigations in the same notes.
•
Clinical context: Given Mr Ahmed’s anxiety
about his symptoms and recent urgent
attendance, the court found it unlikely he
would have ignored a cancer-excluding test if
informed.
•
Audit
trail
evidence:
Post-consultation
prescribing and record closure supported an
inference that key actions may have occurred
after the patient left, without communication.
When you step back and look at the audit trail from
11 February 2019, it essentially reconstructs the
consultation more reliably than any recollection
could. This chronology allowed the court to
reconstruct events with a high degree of precision. It
also reinforces an important medicolegal principle:
primary care records are best understood as timestamped datasets rather than narrative recollections.
You can see the consultation itself: assessment,
examination, clinical reasoning, and a decision to
request imaging. Then you can see the subtle but
crucial timing issue—the X-ray request appears to
have been generated after the patient had left the
room. The same applies to later prescribing and
administrative updates.
2. Causation
The court found Mr Ahmed would have attended
the X-ray if informed, relying on:
•
•
None of this is clinically unusual. It’s how general
practice actually runs: decisions made in real time,
paperwork completed immediately afterwards.
prior compliance with walk-in investigations;
clear concern about his health;
EXPERT WITNESS JOURNAL
43
JUNE 2026
